Complex Reinsurance & Stop-Loss Claims Specialist

CVS Health; South Carolina; Vor Ort; USD 25.000 - 58.000; Vollzeit

Benefits dieser Stelle

Medical coverage

Dental coverage

Vision coverage

Retirement plan

Wellness programs

Paid time off

Zusammenfassung

CVS Health in the United States is seeking a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, splitting tasks across multiple statuses and ensuring adherence to processing guidelines.

You will collaborate with key business units to verify coverage, apply medical necessity guidelines, handle pre-approvals and appeals, and support colleagues through training and mentoring when needed.

Qualifikationen

• 2+ years medical claim processing experience.
• 2+ years in a production environment.
• Excellent communication and organizational skills.

Aufgaben

• Review, research, and adjust complex Reinsurance/Stoploss medical claims.
• Collaborate with key functions to ensure accuracy in adjustments.
• Handle inquiries related to pre-approvals, reconsiderations, or appeals.
• May deliver training and mentor less experienced staff.

Kenntnisse

Medical claim processing

Production environment

Communication skills

Ausbildung

Associate degree or equivalent experience

Jobbeschreibung

CVS Health in the United States is seeking a Reinsurance/Stoploss Claims Adjuster to review, research, and adjust complex medical claims, splitting tasks across multiple statuses and ensuring adherence to processing guidelines.

You will collaborate with key business units to verify coverage, apply medical necessity guidelines, handle pre-approvals and appeals, and support colleagues through training and mentoring when needed.